Former Georgia insurance commissioner pleads guilty to healthcare fraud

A former Georgia insurance commissioner has pleaded guilty to participating in a healthcare fraud scheme that billed private insurers for over $2.5 million in false claims. 

According to a March 22 news release from the Justice Department, John Oxendine pleaded guilty to conspiracy to commit healthcare fraud. Mr. Oxendine conspired with Jeffery Gallups, MD, who owned a chain of ENT practices, to submit unnecessary claims to NextHealth, a Texas-based lab. In 2022, Dr. Gallups was sentenced to three years in prison for his role in the scheme. 

As part of the scheme, Mr. Oxendine gave a presentation to Dr. Gallups' employees, urging them to bill medically unnecessary tests to NextLabs, according to the Justice Department. The lab paid a 50% kickback from profits it made from the false claims to Mr. Oxendine and Dr. Gallups. 

NextHealth charged private insurers over $2.5 million for the tests ordered from Dr. Gallups' practice and was paid almost $700,000 in reimbursements. Mr. Oxendine and Dr. Gallups received $260,000 in kickbacks, according to the Justice Department. Mr. Oxendine received payment through his insurance consulting company, Oxendine Insurance Services, in order to conceal the scheme. 

Mr. Oxendine was Georgia's insurance commissioner from 1995 to 2011. The scheme took place between 2015 and 2017, after he left office, according to The Atlanta Journal-Constitution. 

The former insurance commissioner faces up to 10 years in prison, the Atlanta Journal-Constitution reported. His sentencing is scheduled for July 12. 

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